A Retrospective Study of Parietal Lobe Epilepsy: Functional Anatomy and Surgical Treatment.

Context: Parietal lobe epilepsy (PLE) accounts for approximately 5% of all focal epilepsies worldwide,1 and few PLE patients have undergone epilepsy surgery in the past. With the introduction of functional neuroimaging methods, such as interictal fluorodeoxyglucose-positron emission tomography (FDG-PET), stereotactic electroencephalograms (SEEGs), and high-resolution magnetic resonance imaging (MRI), more patients with intractable neocortical epilepsy have been considered for surgical treatment. Objective: The study intended to characterize the clinical features, aura, and presurgical evaluations of patients with PLE, by investigating their demographic and clinical characteristics, and to evaluate the prognostic value of the four diagnostic modalities-MRI, FDG-PET, scalp EEG, and SEEG-in terms of the localization of epileptogenic area. Design: The research team performed a retrospective analysis of outcomes for PLE patients who underwent resistive brain surgery. Setting: The study took place in the Neurosurgery Department of Epilepsy at the Second Hospital of Hebei Medical University in Shijiazhuang, China. Participants: Participants were 9 PLE patients, 4 males and 5 females, who underwent epilepsy surgery at the hospital between 2017 and 2019. Outcome Measures: The measures included demographic data, seizure data, electroencephalogram (EEG) recordings, magnetic resonance imaging (MRI) of the brain, positron emission tomography (PET), and stereotactic electroencephalogram (SEEG). The pathological findings were reviewed. Results: The five participants who had a PET all had positive results. Eight participants who had parietal lobe lesions had an MRI, and four had a stereotactic electroencephalogram (SEEG) that localized the epileptogenic zone. The interictal scalp EEG recordings for seven participants showed an abnormality, and six participants who had ictal surface EEG recordings showed parietal ictal EEG onset. Conclusions: Surgical excision of epileptogenic foci is the main treatment for drug-resistant PLE. Parietal functional anatomy is the basis for understanding and diagnosing PLE. Aura, semiology, interictal EEG, and PET are an important foundation for evaluation of PLE patients, and the SEEG is the most valuable tool, allowing localization of the epileptogenic zone.

Neurosurgical robot-assistant stereoelectroencephalography system: Operability and accuracy.

BACKGROUND: Fine operation has been an eternal topic in neurosurgery. There were many problems in functional neurosurgery field with high precision requirements. Our study aims to explore the operability, accuracy and postoperative effect of robot-assisted stereoelectroencephalography (SEEG) in neurosurgery. METHODS: We conducted a retrospective analysis of patients with epilepsy who underwent electrode implantation in our hospital. From 2016 to 2019, the epilepsy center of Hebei people's hospital implanted electrodes in neurosurgery on 24 patients, including 20 with SINO robot-assisted SEEG system and eight with frame-SEEG technology. RESULT: Robot-assisted SEEG neurosurgery had higher accuracy, and the mean error of entry and target point was smaller than that of frame SEEG surgery. No bleeding or infection occurred postoperatively, and two patients who underwent robot-assisted SEEG neurosurgery had electrode displacement. Electrode displacement was observed in two patients, both the entry points were orbital frontal, one in the frame system and one in the robot assistant system. The average placement time of each electrode in robot assisted system surgery was less than that in frame system surgery. CONCLUSION: The SINO SEEG electrode implantation assisted by surgical robot-assistant system manufactured in China is safe, accurate and mature.

Robot-assisted versus stereotactic frame-based stereoelectroencephalography in medically refractory epilepsy.

AIM: To explore the difference between robot assisted (RA) and stereotactic frame based (SF) stereoelectroencephalography (SEEG) in patients with medically refractory epilepsy. METHODS: We undertook a retrospective review of 33 SEEG cases at our center, of which 14 were SF performed from March to October 2018 and 19 were RA performed from November 2018 to December 2019. Detailed review of medical histories and operative records as well as imaging and trajectory plans was carried out for each patient, and the results related to each technique compared. A multiple linear regression model was used to test for variables that significantly influenced placement error. RESULTS: Compared to the SF group, the RA group had a higher mean number of electrodes per patient (10.7 ±â€¯2.8 versus 6.4 ±â€¯0.8, P < 0.0001) and a significantly shorter mean operative time (127.3 ±â€¯40.7 versus 152.7 ±â€¯13.6 min, P = 0.033). For the RA group, the intracranial implantation length was positively correlated with target point error (p = 0.000), depth error (p = 0.043), and two-dimensional (2D) radial error (p = 0.041). Conversely, skull thickness was negatively correlated with the TP error (p = 0.004), depth error (p = 0.037) and 2D radial error (p = 0.000). We also analyzed the mean entry point, target point, depth and 2D radial errors, the complication rates, and the results of epileptogenic zone (EZ) localization and Engel class. The results showed no difference in these aspects between the SF group and the RA group. CONCLUSION: This study suggests that, compared to stereotactic frame based SEEG, robot assisted SEEG is significantly more efficient and comparable in safety and effectiveness.